Dermatology undergraduate skin cancer training: a disconnect between recommendations, clinical exposure and competence

Three linked studies were undertaken. In the first, students’ competence was tested by randomized slideshows of images containing the 16 lesions recommended in the UK guidelines. Students’ accuracy was tested at the beginning (Day 1) and end (Day 10) of their clinical placement, with a random sample of students retested 12？months later. Secondly, students’ exposure to these lesions was recorded during their attachments. Finally a survey of the additional dermatological resources used by the students was undertaken.Study 1: Students’ diagnostic accuracy increased from 11% on Day 1 to 33% on Day 10 (effect size +2.72). After 12？months half of this effect had disappeared and the students accuracy had dropped to 24%. Study 2: Students’ exposure to the recommended lesions was poor with 82% not even witnessing a single example of each of the 3 major skin cancers. Despite these measurements, only a minority of students reported that they were not confident at diagnosing skin tumours. Study 3: The majority of students use additional resources to supplement their learning.In the light of what we know about learning in dermatology, our data would suggest, that the current (traditional) undergraduate attachment is inadequate to meet the UK recommendations for graduate competence. As well as critically examining the basis for these recommendations, we need more empirical data on student performance and exposure, in order to improve teaching and learning.Cutaneous malignancies account for over a quarter of all new ‘cancer’ diagnoses in the UK [1]. Diagnosing skin cancer is largely a perceptual skill, relying little on formal or explicit rules, but rather on prior exposure and feedback either in a training environment or in the clinic. Following Norman’s terminology, the skills involved are largely thought to be those of non-analytical pattern recognition (NAPR), and this core skill can be viewed as being able to attach semantics to images or percepts [2-10].In the UK general pra